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Brachial palsy, also known as Erb’s palsy, is a serious medical condition caused by a shoulder injury that may occur during the birthing process. Newborns who sustain a shoulder injury at birth affecting the network of nerves that facilitate communication between the spine and arm, known as the brachial plexus, experience immobility or weakness of the arm on the affected side. Brachial palsy may manifest in varying forms and degrees depending on the extent of paralysis. Treatment for this condition is dependent on the extent of the paralysis and may necessitate surgery to repair nerve damage.
There is a variety of situations that may contribute to the development of Erb's palsy. Injury may be sustained during delivery if the infant’s head and neck are pulled to one side to allow for passage through the birth canal or if there is excessive pressure placed on the infant’s arms if he or she is delivered breech, or feet first. Additionally, if the infant’s shoulders are pulled in order to facilitate delivery, there may be a risk of nerve damage if too much pressure is used.
The presentation of arm paralysis is dependent on the extent of injury the brachial plexus sustained. Mild injury to the brachial plexus generally affects only the upper portion of the arm. Infants diagnosed with brachial palsy experience paralysis of both the upper and lower arm. If the infant’s forearm and hand are adversely affected by the sustained nerve damage, she or he may be diagnosed with a condition known as Klumpke’s paralysis.
Infants with brachial palsy may exhibit a variety of symptoms. An inability to grip objects or move either the arm or hand may be signs indicative of Erb’s palsy. If the child’s arm is bent at the elbow and held close to his or her body, he or she may also be symptomatic.
Brachial palsy is generally diagnosed during a physical examination which demonstrates that the child is not moving his or her arm normally. If the child’s arm falls or flops when she or he is turned to one side or another, it may be a sign of paralysis and indicative of Erb’s palsy. If brachial palsy is suspected, the child may undergo further examination, including an X-ray, to rule out the existence of a collarbone fracture that may present with similar symptoms.
Treatment is dependent on the presentation and severity of the condition. For most mild cases, range-of-motion exercises and regular massaging of the affected area are recommended. Infants with severe presentations of the condition may be referred to a specialist for treatment. Children who undergo non-surgical treatment are monitored for improvement for several months. If the child does not show improvement by the time she or he is six months old, surgery may be necessary to repair nerve damage and restore some strength and flexibility to the affected area.
Children who receive a timely diagnosis and appropriate treatment tend to completely recover within six months to one year. Infants who do not show improvement within six months of diagnosis and treatment are more likely to require additional treatment. In cases where fracture has induced pseudoparalysis, the child may regain use of his or her arm once the break has healed.
Since cesarean deliveries have become more commonplace for difficult deliveries, occurrences of brachial palsy have diminished. Symptoms associated with Erb’s palsy do mimic those of other conditions, including pseudoparalysis, so additional testing and examination should be performed to confirm a diagnosis. Complications associated with Erb’s palsy include unusual muscle contractions in the affected area that may become permanent and the partial or total loss of nerve function in the affected area, which may be permanent. Certain situations increase the risk for Erb's palsy, including breech delivery and the vaginal delivery of an above-average size infant. The risk for Erb's palsy may be reduced by taking the appropriate precautionary measures to avoid a difficult vaginal delivery.